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Schmitz L, Büscheck F, Betz CS, Böttcher A. An unusual clinical presentation of a plunging ranula-The plunging ranula with extension to the vallecula. Clin Case Rep 2024; 12:e8964. [PMID: 38883226 PMCID: PMC11176729 DOI: 10.1002/ccr3.8964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Key Clinical Message A plunging ranula may present initially as an extensive vallecular cyst and correct diagnosis may be reached with the use of ultrasound, fluid aspiration for amylase detection, and MRI imaging. Abstract The ranula is a pseudocyst of the sublingual salivary gland and can be divided into two known subtypes. The simple ranula and plunging ranula. While the simple type can be found in the floor of the mouth, the plunging ranula usually pervades the mylohoid muscle and presents as a cervical swelling. The presented case should outline the difficulties in diagnostic and treatment of an uncommon expression of a mucocele above the mylohoid muscle without presenting either a cervical or an intraoral swelling, only extending towards the vallecula. We present a previously unreported clinical manifestation of a ranula of an 18-year old male, which extends posteriorly, remaining confined in the supramylohyoid muscle space. The cystic lesion protrudes in the oropharynx, and clinically appears as an extensive vallecular cyst. On magnetic resonance imaging the initial suspected diagnosis of a vallecular cyst was changed to the final diagnosis of a plunging ranula. The marsupialization of the cyst sac was performed. Outpatient follow-up revealed a persisting ostium, indicating a continuous extravasation of the sublingual gland. The present case report describes an unusual clinical presentation of a plunging ranula, remaining above the mylohyoid muscle and protruding into the oropharynx, misdirecting to the first suspected diagnosis of a vallecular cyst. The case highlights the useful contribution of the MRI imaging for differential diagnoses and the need for criteria to indicate further investigations.
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Affiliation(s)
- Lisa Schmitz
- Department of Otorhinolaryngology University Hospital Hamburg-Eppendorf Hamburg Germany
| | - Franziska Büscheck
- Department of Pathology University Hospital Hamburg-Eppendorf Hamburg Germany
| | - Christian Stefan Betz
- Department of Otorhinolaryngology University Hospital Hamburg-Eppendorf Hamburg Germany
| | - Arne Böttcher
- Department of Otorhinolaryngology University Hospital Hamburg-Eppendorf Hamburg Germany
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Song T, Chiu W, de Paiva Leite S, Ahmad Z, Mahadevan M, Harrison JD, Jain P, Morton RP. Amylase as a Diagnostic Tool for Plunging Ranula: Clinical Series and Description of the Technique. Laryngoscope 2023; 133:535-538. [PMID: 35670504 DOI: 10.1002/lary.30243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/23/2022] [Accepted: 05/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study describes a technique of measurement for neck cyst amylase content and reviews the experience of a tertiary referral center for cases of suspected plunging ranula. METHODS A retrospective study was performed at the Manukau Surgical Center in Auckland, New Zealand. Patients with a possible diagnosis of plunging ranula based on clinical presentation and diagnostic aspiration of the cyst contents were included. Demographic data, imaging and laboratory findings were collected, along with findings from surgery and histology. The technique for measuring the amylase of the aspirated cyst contents was also carefully recorded. RESULTS The 37 cases of confirmed plunging ranula included in this study had a submandibular cystic swelling that was aspirated. Imaging features consistent with a plunging ranula were seen in 89% of the study group. All cases had detectable levels of amylase of ≥3 U/L in the ranula contents. There was large variability (range: 5-560 U/L) in the concentration of amylase, with 70% of the cases demonstrating an amylase concentration below 200 U/L. Aspirates were typically described as viscous (87.5%) and yellow or straw-colored. CONCLUSION The combination of clinical presentation, imaging and the presence of amylase in the cyst contents is diagnostic for plunging ranula. LEVEL OF EVIDENCE 4 Laryngoscope, 133:535-538, 2023.
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Affiliation(s)
- Thomas Song
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand
| | - Weldon Chiu
- Biochemistry laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sandro de Paiva Leite
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John D Harrison
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Prabha Jain
- Department of Radiology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Ultrasound in the diagnosis and differential diagnosis of enoral and plunging ranula: a detailed and comparative analysis. J Ultrasound 2022:10.1007/s40477-022-00743-7. [DOI: 10.1007/s40477-022-00743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
Abstract
Purpose
To develop sonographic criteria for ranula that to allow rapid and precise diagnosis, differentiation between enoral (ER) and plunging ranula (PR), and differential diagnosis from other competing pathologies in this region.
Methods
Patients who presented with or were referred with ranula between 2002 and 2022 were assessed in a retrospective study. After clinical investigation, ultrasound examinations were performed in all cases. Several sonographic parameters describing the echotexture, shape and size of ranulas, their relationship to important surrounding anatomical landmarks and the characteristic spreading pattern of ERs and PRs were elaborated and evaluated.
Results
207 ranulas were included (82.12% ERs and 17.87% PRs). The ranulas were all in close anatomical relationship to the sublingual gland (SLG) and mylohyoid muscle (MM). The echo texture was hypoechoic to anechoic in 97.6% of the lesions. In comparison with ERs, PRs were larger and irregular in shape significantly more often (P = 0.0001). There were significant differences between ERs and PRs in their exact location relative to the SLG (superficial, deep, anterior, each P = 0.0001; posterior, P = 0.03) and level of the MM (above, below, above and below, P = 0.0001 each). The exact extent and plunging pattern were depicted in all PRs, but naturally in none of the ERs.
Conclusions
The ultrasound criteria developed in this study, confirming previously published results, indicate that ultrasound is an excellent diagnostic tool for diagnosing ranula and differentiating between ERs and PRs.
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Minkov M, Pourkarami A, Franz P, Minkov M. [Little frog in the mouth: a visual diagnosis?]. Wien Med Wochenschr 2022; 173:188-191. [PMID: 36136278 DOI: 10.1007/s10354-022-00964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
Ranula, from the Latin "little frog", is a retention cyst filled with saliva in the oral cavity. Simple ranulas most commonly affect the sublingual gland and typically present as a hemispherical bluish cyst on the floor of the mouth, making it a visual diagnosis. A 7-year-old girl presented with a swelling on the underside of the tongue, an uncommon location for a ranula that made diagnostic assignment difficult. The optimal treatment of a ranula is still controversial in the literature. Many authors favor surgery as the treatment of choice. Our case shows that a watch and wait approach with simple mechanical pressure on the cyst can be sufficient.
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Affiliation(s)
- Martina Minkov
- Medizinische Fakultät, Sigmund Freud PrivatUniversität, Wien, Österreich
| | - Anna Pourkarami
- Institut für Radiologie, Klinik Floridsdorf, Wien, Österreich
| | - Peter Franz
- Lehrstuhl für HNO mit Schwerpunkt Otologie, Sigmund Freud PrivatUniversität, Wien, Österreich.,Abteilung für Hals‑, Nasen-, und Ohrenkrankheiten, Klinik Landstraße & Klinik Donaustadt, Wien, Österreich
| | - Milen Minkov
- Lehrstuhl für spezielle Pädiatrie, Sigmund Freud PrivatUniversität, Wien, Österreich. .,Abteilung für Kinder- und Jugendheilkunde, Klinik Floridsdorf, Wiener Gesundheitsverbund, Brünner Str. 68, 1210, Wien, Österreich.
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Harrison JD. The persistently misunderstood plunging ranula. Am J Otolaryngol 2022; 43:103276. [PMID: 34763952 DOI: 10.1016/j.amjoto.2021.103276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- John D Harrison
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, England, UK.
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Chen N, Zeng DS, Su YT. Role of ranulas in early diagnosis of Sjögren’s syndrome: A case report. World J Clin Cases 2021; 9:5701-5708. [PMID: 34307628 PMCID: PMC8281396 DOI: 10.12998/wjcc.v9.i20.5701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the presentations of Sjögren’s syndrome (SS) are variable, ranging from mild dryness to wider systemic involvement, ranulas as early clinical signs were scarcely reported. Here, we present an adult patient with SS, who developed a unilateral simple ranula and was diagnosed primary SS 3 years later. We also provide a review of cases of SS and ranulas from 1980 to 2020.
CASE SUMMARY A 22-year-old girl was found to have a left painless floor-of-mouth lesion 3 years ago, without obvious trauma or inducement. The diagnosis of a unilateral (left) simple ranula was made, and the ranula was surgically treated. Within 3 years after the ranula surgery, she developed acute lymphadenectasis in unilateral parotid twice without inducement, and ultrasonic examination revealed diffuse lesions in bilateral parotids and submandibular glands, which strongly suggested SS. Serologic tests and the unstimulated whole saliva flow rate confirmed the SS diagnosis.
CONCLUSION Our study underlines that ranulas are early clinical signs of SS. As early diagnosis and early intervention of SS are important to obtain better outcomes, our findings underline the need for histopathological test after sublingual adenectomy and imaging detection of exocrine glands for the patients with ranulas.
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Affiliation(s)
- Na Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai, China
| | - Da-Shun Zeng
- Department of Oral Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Yu-Tong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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The mystery of the misunderstood plunging ranula: Commentary on ‘Surgical treatment of plunging ranula: Report of three cases and review of literature’. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Than JK, Rosenberg TL, Anand G, Sitton M. The importance of sublingual gland removal in treatment of ranulas: A large retrospective study. Am J Otolaryngol 2020; 41:102418. [PMID: 32087991 DOI: 10.1016/j.amjoto.2020.102418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Investigate the efficacy of sublingual gland removal for the treatment of simple and plunging ranulas. MATERIALS AND METHODS After IRB approval, a retrospective review was performed on patients treated for a ranula from February 2013 to May 2018 at Texas Children's Hospital in Houston, TX. Clinical data was collected from medical records and patients were contacted in November 2018 to obtain additional information about recurrences or complications. RESULTS This study included 52 patients with ranulas (10 plunging, 42 simple; M:F 21:31) with a mean age of 9.68 years. Eighteen patients provided information in the extended follow-up period. Simple ranulas were treated with intraoral excision of the cyst and the sublingual gland (27 cases), marsupialization (7 cases), intraoral excision of the cyst alone (7 cases), and intraoral excision of the cystic component and subsequent marsupialization after recurrence (1 case); intraoral excision of the sublingual gland was not associated with any recurrence. Plunging ranulas were treated with intraoral excision of the cyst and/or sublingual gland (7 cases) or with a transcervical approach (3 cases). One patient was initially treated with sclerotherapy before undergoing intraoral excision of the sublingual gland. Two patients treated with transcervical excision of the cyst experienced recurrence compared to no recurrence with intraoral excision of the sublingual gland. CONCLUSION Intraoral removal of the sublingual gland is the most effective treatment for both simple and plunging ranulas. Plunging ranulas must be considered in patients presenting with a submandibular and submental cystic mass given intraoral extension may not be apparent.
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Affiliation(s)
- Jeffrey K Than
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States of America.
| | - Tara L Rosenberg
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
| | - Grace Anand
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
| | - Matthew Sitton
- Department of Otolaryngology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, United States of America
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ALTIN F, ALİMOĞLU Y. Retrospective analysis of ranula patients managed with surgical treatment. ENT UPDATES 2020. [DOI: 10.32448/entupdates.688446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Yin T, Jain P, Ahmad Z, Harrison JD, Morton RP. Bilateral Plunging Ranulas in South Auckland: Evidence for a Genetic Basis. Laryngoscope 2020; 131:73-77. [PMID: 32109322 DOI: 10.1002/lary.28593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We present a series of bilateral plunging ranula patients to examine the etiology, diagnosis, treatment, and prognosis of this condition. METHODS A retrospective chart review was performed on all cases of plunging ranula treated at the Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, New Zealand, between 2001 and 2019. RESULTS There were 17 patients with bilateral plunging ranulas from a total of 187 plunging ranula patients. Eight patients were of Pacific Island descent; six were Maori; and three were Asian. There were no European patients with bilateral plunging ranulas. There were three types of bilateral plunging ranula patients: 1) Metachronous plunging ranulas-Five patients presented with a unilateral plunging ranula with no evidence of a contralateral plunging ranula on initial imaging. Despite negative contralateral imaging findings, these patients developed a clinically evident contralateral plunging ranula 21 to 61 months later. 2) Synchronous plunging ranulas detected on imaging-Eight patients presented with a clinically evident unilateral plunging ranula but also had a contralateral plunging ranula detected on imaging. 3) Clinically evident synchronous plunging ranulas-Four patients presented with bilateral clinically evident plunging ranulas, which were also evident on imaging. Twelve patients underwent bilateral transoral sublingual gland excision and plunging ranula evacuation. CONCLUSION All patients with a unilateral plunging ranula should be advised of the potential for developing contralateral disease, and this should be emphasized in patients of Pacific Island, Maori, and Asian descent. LEVEL OF EVIDENCE 4 Laryngoscope, 131:73-77, 2021.
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Affiliation(s)
- Tary Yin
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Prabha Jain
- Department of Radiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
| | - John D Harrison
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Manukau Surgery Centre, Counties Manukau District Health Board, Auckland, New Zealand
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